title: Major gaps in diabetes clinical care among Canada's First Nations: results of the CIRCLE study.
abstract: OBJECTIVE
  The aim of this cross-sectional study was to document the clinical management of type 2 diabetes and related complications in Canada's First Nations.
  
  
  METHODS
  Patients were randomly selected from 19 communities. Data from charts from consenting patients were collected.
  
  
  RESULTS
  Of 885 patients, 63.3% were female, mean age was 54.9 years and mean duration of T2DM was 11.2 years. Mean A1C was 8.2%; 61.1% of patients had an A1C >7.0%; mean LDL was 2.4 mmol/L; 92.6% had dyslipidemia; mean systolic BP was 132 mm Hg; mean diastolic BP was 76 mm Hg; 92.0% had hypertension. Lipid-lowering medications were prescribed to 62.9% of those with dyslipidemia and an LDL-C >2.0 mmol/L. Of hypertensive patients, 15.8% were not on an antihypertensive agent. For vascular protection, 55.1% were on a statin, 72.1% on an ACE inhibitor or ARB, and 64.5% on an anticoagulant. Smoking was documented in 39.4%, 92.1% were overweight/obese; 55.1% had chronic kidney disease, and 13.3% had coronary artery disease.
  
  
  CONCLUSIONS
  Major care gaps were revealed, with most patients not achieving glycemic, lipid and BP targets. Over half of this relatively young cohort had established microvascular disease. Macrovascular disease rates may increase dramatically due to the high prevalence of risk factors.
authors.affiliation: Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, 245-100 Collip Circle, UWO Research Park, The University of Western Ontario, London, Ontario N6G 4X8, Canada. sharris1@uwo.ca
authors.forename: Stewart B
authors.initials: SB
authors.lastname: Harris
authors.forename: Mariam
authors.initials: M
authors.lastname: Naqshbandi
authors.forename: Onil
authors.initials: O
authors.lastname: Bhattacharyya
authors.forename: Anthony J G
authors.initials: AJ
authors.lastname: Hanley
authors.forename: James G
authors.initials: JG
authors.lastname: Esler
authors.forename: Bernard
authors.initials: B
authors.lastname: Zinman
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D015992:Body Mass Index; D002170:Canada / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D007198:Indians, North American; D007674:Kidney Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects
chemical_list: D000959:Antihypertensive Agents